Prevalence and determinants of modern contraception use among persons with disabilities in low- and middle-income countries: A systematic review and meta-analysis.

BACKGROUND

People with disabilities have the same need for contraception as the general population. However, their access to modern contraceptive methods is largely underexplored in low- and middle-income countries.

OBJECTIVE

This study aimed to explore the prevalence of modern contraception use among reproductive-aged (15-49 years) persons with disabilities in low- and middle-income countries and identify the key determinants.

METHODS

In June 2024, we conducted a systematic search across six databases including PubMed, Web of Science, Embase, Global Health, Medline and Scopus to identify studies on disability and modern contraception in low- and middle-income countries. The search terms included a combination of Medical Subject Headings (MeSH) terms and keywords related to disability, modern contraception and low- and middle-income countries integrated using the Boolean operators (AND, OR). All studies published between January 2015 and June 2024, in English, and conducted in low- and middle-income countries were included. The primary outcomes were the prevalence of modern contraception use and its determinants among persons with any disability. Summary estimates were calculated using meta-analysis with a fixed effects model for lower heterogeneity. Random effects meta-analysis was used for mid-level heterogeneity (50%-74%) and high-level heterogeneity (75%-100%).

RESULTS

A total of 18 studies from low- and middle-income countries were included, with 11 included in the meta-analysis. The pooled prevalence of modern contraception use among persons with disabilities was 31.4% (95% CI: 26.5, 36.2). Significant heterogeneity was observed across respondent characteristics (I = 94.55%). Five factors were significantly associated with higher contraception use: being aged over 25 years, having some level of education, being in a higher wealth quintile, having adequate knowledge of family planning and being in a formal marital relationship.

CONCLUSION

This study reveals a significantly lower prevalence of modern contraception use among persons with disabilities in low- and middle-income countries compared to the general population. Improving access to education, addressing social norms and strengthening healthcare systems may contribute to increasing access to contraception and uptake among persons with disabilities in low- and middle-income countries.